Agency Info:
Name : NEWS Insurance Services, Inc.
License ID : 0E61920
Phone : (877) 400-9990
Email : [email protected]
Address : Suite A, Newport Beach, CA, 92660
Rep Agent Info:
Name : Barry M Kamran
License ID : 0617751
Phone : (949) 791-1300
Email : [email protected]

Auto

  • Applicant
  • Carrier
  • Drivers
  • Vehicles
  • Coverage
  • Finish

Applicant

Can you tell us about yourself?

First Name *
Last Name *
Date of Birth *
Marital Status

Where should we send your Quote?

Home Address
Address *
City *
State *
Zip Code *
Email *
Phone *

What is your occupation or education degree

Education Level
Industry /​ Occupation
Specify (Industry/​Occupation) *
School Name *
School Address
Address *
City *
State *
Zip Code *
Company Name *
Company Address
Address *
City *
State *
Zip Code *

Please fill all the mandatory questions.

Carrier

Please tell us about your current insurance

Current Auto Insurance Carrier *
Current Auto Insurance Expiration Date *
Current Premium
Are you being cancelled or non-renewed?
What is the Reason?

Please fill all the mandatory questions.

Drivers

Driver 1

Can you tell us about the Driver?

Full Name *
Relationship to the applicant
Date of Birth *
Marital Status

What does he/she do for a living?

Education Level
Industry /​ Occupation
Specify (Industry/​Occupation) *
School Name *
School Address
Address *
City *
State *
Zip Code *
Company Name *
Company Address
Address *
City *
State *
Zip Code *

License Information

Driver's License Number *
License State
Age Licensed (Years)

Ticket 1

License Information

Type of Ticket
Date of Ticket

Accident 1

License Information

Type of Accident
Date of Accident

Please fill all the mandatory questions.

Vehicles

Vehicle 1

Vehicle Details

What is the VIN Number
Purchased Date
Year *
Make *
Model *
Body Style

Usage for the Vehicle

Vehicle Usage
Annual Mileage *
Mile to work
Odometer Reading

Please fill all the mandatory questions.

Coverage

Bodily Injury *

(Per Person / Per Accident in $1000)

Property Damage

(Per $1000)

Uninsured /​ Underinsured Motorist
Uninsured Motorist Property Damage
Medical
Comprehensive Deductible *
Collision Deductible *
Rental Reimbursement

(Per day / Maximum 30 days)

Please fill all the mandatory questions.



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